Organization
BANDERA SCC LLC
Active
Other names
Bandera Nursing & Rehab Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICAHEL BEAL (CHIEF EXECUTIVE OFFICER)
(214) 252-7600
Entity
Organization
Contact information
Practice address
222 FM 1077, BANDERA, TX 78003-4765
(803) 796-4077
(803) 796-3539
Mailing address
600 N PEARL ST STE 1050, DALLAS, TX 75201-7495
(214) 252-7600
(214) 252-7704
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001026809
—
TX
01
—
5557 103936
VENDORID/FACILITY ID
TX
Enumeration date
12/16/2014
Last updated
03/04/2020
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